At the end of November, the Royal College of Physicians and Surgeons in Glasgow played host to a joint BGS/JCHMT meeting on the future of training in geriatric medicine.

A cross section of consultant and trainee geriatricians attended the event, which was designed to shed light on how training might evolve under the impact of Modernising Medical Careers (MMC) and run-through training.

Dr Nicki Colledge outlined current SpR training and curriculum, noting that the JCHMT generic skills curriculum maps closely to the GMC standards for good practice. The tension between training in general internal medicine and geriatric medicine was widely acknowledged to be a source of concern.

Professor Ken Cochrane outlined the proposed structure for Modernising Medical Careers. Though not yet finalised, run through grades will be introduced from 2007. During the F2 year, individuals will apply for a generic ‘Basic Medical Training’ post. During this two-year period, they will be selected for higher specialist training as part of the run-through scheme. This may surmount the problem of having to select a specialty during F2.

MRCP Part 1 will be taken during basic medical training, and PACES will be passed by the end of the first year of higher specialist training. It is less clear what will happen to people who cannot or do not want to go into run-through training. Time limited posts (1-2 years) will be available with a limited training component, with the option to then apply for run-through training or staff-grade/associate specialist type posts.

Dr Ian Starke, chair of the internal medicine Specialist Advisory Committee (SAC), discussed the rise of the acute physician. Even with a planned 150 new SpR posts per year, it will take 20 years to reach the desired level of three acute physicians in every acute trust. This means that geriatricians will be involved in the acute medical take for many years to come!

Dr Sally Briggs presented the latest update on career decision choices in geriatrics. The major influences on choosing geriatrics were role models and positive clinical experiences. Most people make the choice to do geriatrics relatively late in their training. Seventy per cent of SpRs said that geriatrics was their first career choice; however, 10 per cent of SpRs and 10 per cent of consultants regretted their choice of career. This may produce negative feedback to some people considering a career in geriatrics.

Prof John Gladman outlined the four possible uses for academic training sessions: research, teaching, MSc and quality assurance. Although individuals do not have to use the sessions for research, a tangible output is necessary and should be assessed at the RITA. Prof Paul Baker outlined one way of spending the sessions - the highly structured SpR teaching programme in the North-West deanery, complete with web-based teaching support and an optional MSc programme run by the University of Salford. Positive feedback was received from trainees on the programme, and the study leave budget is now underspent, as trainees feel that many topics are well covered locally.

Professors Steve Allen and Tash Masud reviewed the new methods of SpR assessment. 360 degree appraisal is now with us, and even trainees now in 3rd/4th year should probably do one round before PYA. Data presented show trainees find the exercise more useful if the supervisor, rather than the trainee, distributes the forms.

Knowledge based assessment will be trialled nationwide on 18th May 2006. If all goes well, the exam will be introduced in 2007, and will be sat in the first two years of higher specialist training. Multiple attempts will be allowed, with two sittings per year, and the exam is designed to establish a minimum level of competency; thus the intention is to get everyone to pass it.

Prof Tim Hendra, chair of the SAC in Geriatrics, outlined the proposed categories of subspecialty training: stroke, continence, falls, orthogeriatrics, movement disorders, community geriatrics and psychogeriatrics. All trainees will be encouraged to train in a subspecialty, and can count one of the five years doing subspecialty training or research. Those wishing to undertake a year of research plus a subspecialty, or who want to train in two subspecialties, would need to extend training by a year. It is possible that in future, subspecialty training may occur after award of the CCT.

Dr Jeremy Playfer, BGS President, rounded off the meeting with poetry and some wide-ranging remarks on the need for well-rounded doctors and a good evidence base being vital to the continuing health of geriatrics. The challenge will be to implement the new training paradigm without losing sight of what is best for older people now and in the future.

Miles Witham
Simon Conroy